Department of Health

Gary Dowsett

  • 24 September 2015
  • Duration: 26.16
  • Size: 21.18 MB

Speaker 1: Professor Gary Dowsett, Director, Australian Research Centre in Sex, Health and Society, La Trobe University

Many thanks for the invitation to be here this morning and may I too acknowledge the traditional owners of the land on which we're meeting and their Elders past and present.  And particularly may I acknowledge the Elder men of our indigenous inhabitants of this area and the leadership that they provide, particularly indigenous men's health in Australia where they are a very, very strong voice for men's health in this country.

I will talk a little about HIV and prostate cancer which are my two main research areas in passing, but I think my job in the title I was given was really to be the egghead here today and do theory because that's what I like to do.  So I'm going to do a bit of theory.  I hope that's not going to be too much of a problem, but I will try and relate that to some practical things as we go. 

I mean I suppose the first thing is to take the word that everyone uses in relation to men's health and men's studies and that's masculinity which has become the problematic term or the problematizing term that we use most of the time in trying to understand what's happening in men's health.  And I'd like to start by questioning this term and suggesting we've got problems with it as a way of thinking about what's going on.  I mean it's a very new term. 

My father's and my grandfather's generation would never have talked about masculinity in the way that we talk about it today.  They might have seen it as something to do with being an attribute or a character.  They might have said he's a man's man, which I thought was a really weird phrase from ever since I was a small boy, but they would never have talked about someone's masculinity as a problematic area.  But we now do and I think that's been a significant shift in the way that we think about men and we think about understanding why men are like they are.

Men's health is fairly new in this country and indeed masculinity theory and men's health arise at almost the same time and one of the key players in that area is Australian sociologist, Raewyn Connell whom some of you I know may have referred to.  Connell actually, she was commissioned with a number of other people by Carmen Lawrence to produce a fairly interesting report on men's health in the 90s, finally published after the government fell from power.  Michael Wooldridge in fact signs this off, but this was a really interesting report reshaping the agenda in Australia for men's health, but went in to an abeyance for quite some time and took about another 10 years for people to start paying attention to some of the ideas that are in here.

It's hard to find, but I'd recommend going back and having a look at this in terms of the way in which issues of thinking about men's health in this country were originally set up because this is a really seminal document in the setting up of that agenda and Connell of course is the major theorist of masculinity studies globally.  She actually established the field of studies and leads the world in this area and so we use a lot of her ideas in thinking about men and men's health often without recognising it.

The other source of ideas here is obviously second wave feminism and the women's movement for the last 40 years who have problematized men, men's behaviour, their fathering, their parenting practices, their sexual behaviour et cetera for a long time.  And a lot of what we think about in terms of men and men's health has been influenced by that agenda.  Sometimes that agenda is still old; it has what I call sticky feet.  In the 60s and 70s I think men have moved on and I think younger men have moved on more and at times we need to rethink some of the headlines we're used to using when we think about men and men's health. 

I suppose the key issue I want to put on the agenda today is men's health is not just about individual men and health tends to be about individuals and individual behaviours and individual conditions, but a lot of what we need to understand about men's health - and I'm a sociologist so you can see where I'm going to come from - is actually structural and institutional.  It's the situation of men in society that produces many of the things that we see on the end of the clinical agenda in men's health and that's where I'd like to pay some attention today.  I'm not going to present any data on illnesses and diseases.  I want to look at the structural and institutional underpinnings of men's health as it happens in this country.

So we take this problem of masculinity first of all and I suppose the thing, the key concept that we use in this area and many of you may heard of it as called hegemonic masculinity.  It's in a lot of the literature on men's health; it's a terribly misused phrase.  What most people think it means is what is the dominant form of masculinity we're all supposed to live up to as men and how come that's damaging for us?  That's really how a lot of people use this. 

That's not what Connell meant when she developed this term 30 years ago.  What Connell was saying at the time was there is an ideology or a set of ideas about what should be the proper and best form of masculinity that men struggle to achieve and most fail and that that's the major dynamic in men struggling to be masculine in our culture that is, a sense of permanently failing to live up to an impossible ideal. The example Connell uses in her earliest work on this - which I was actually a part of - is the First XI cricket team in a school. 

Every boy who plays cricket wants to be in the First XI cricket team and everybody struggles to be in the first XI.  They are held up as the pinnacle of the best sportsmen in cricket, if you're interested in cricket.  We could do the first 15 or the first 18, depending on your footie if you wanted to, but let's stay with the First XI.  Now the fact of the matter is there are only 11 places or 12 places in the First XI cricket team.  Everybody else by definition cannot get in, no matter what.  So everybody else fails right from the start to not be in the First XI no matter how hard they try, no matter how they believe they ought to be that good. 

So in a sense Connell's argument here is the system is set up for failure right from the start; the way we bring up boys, what we ask of them, what we ask them to strive for pretty much sets them up to not achieve it and that sense of most boys being second best at everything because there's only 11 who are good is what actually is one of the great characteristics of Australian masculinity.  And one might ask the question then, how does that permanent sense of underlying inadequacy determine how the rest of us behave throughout our lives as men and what we try and do with ourselves? 

The second issue that Connell talks about is subordination and her argument here is that as a result of everybody else being in the second, fourth, fifth, sixth, seventh, eighth, ninth, tenth cricket team or not even getting in to the cricket team if you can't see straight or run - which is my situation - what sort of masculinity do you think yourself as having?  And she talks about subordinated masculinity, not just other ones or different ones, but ones that are actually regarded as inadequate.  So compounding this sense of failure that most boys might have of never quite living up to the mark is the idea that if you even are good at chess you are still a nerd because you're not in the cricket team and champion chess players don't rate. 

So essentially there are other kinds of ways of even achieving that you might be proud of as a man.  Being a good singer in the choir doesn't rate, but other kinds of ways of living a life as a man do not in fact meet this ideal mark that we're supposed to live up to and many men who strive to achieve in these other areas still carry around a kind of feeling that yeah, even though I'm the best chess player in the school or even I'm the leading boy in the choir, I still don't really count in the way the system works. 

And I think understanding this notion of subordinated masculinity is this hierarchy of power.  What's the most influential, what's the least influential, is a bit more sophisticated than what we tend to see in the men's health literature which is an argument about just a diversity of masculinities as if there's cans on a shelf and they've got slightly different labels and you can choose any one you'd like.  That's not the key part of this theory.  The key part of this theory is about a hierarchy; a hierarchy of approval and disapproval, a hierarchy of achievement and failure and that to me is a much more powerful way of understanding the dynamics of relationships between men. 

And then if we think about where that shifts it underpins quite strongly often men's relationships to women.  That sense of subordination or being less than adequate and in fact impact upon gender relations in a very important way.  Indeed Connell goes on to talk about not just gender as the difference between men and women, but to talk about the gender order that is the structure of gender in our society.  How it operates, how it's divided up, how it's understood historically, how it's come about culturally and what she calls gender regimes and that is the way institutions like workplaces, schools, financial systems, the labour market, are also actually built on these kinds of systems of inequality and subordination.

And if you play with that you start to see things like the differences between men being older or younger, being infirm or disabled or not, being of a different racial or ethnic group.  You start to see being a different social background and class in terms of economic achievement.  You start to see these differences not again as just a list of differences between people, but in fact a hierarchy of relationships where some are valued more than others and some are subordinated to others at various times.

And we can see in this argument the way in which some men and the way they respond to their lives, their circumstances and therefore their health may be contextualised in this dynamic, this social dynamic of inequality, this power system about what constitutes a man, a proper man and what is not and where women fit in that particular hierarchy.  I think this is a much more complex way, but I think it's also a much more useful way to then look at some of the things that we find when we look at the data on men's health that we receive. 

Another area I'd like to add in here is the sexuality and the body.  I'm a sexuality researcher so this is the area that I play in and it's often an area that's disregarded.  We problematize men's sexuality as rapists or abusers, but we never really know how to ask the question what are men's legitimate sexual interests?  Can we conceive of the notion of men of actually having legitimate sexual interests or only illegitimate sexual behaviours?  And if you look at most of the literature in this area it's the latter.  Illegitimate sexual behaviours that we focus on and we can't quite see what the possibilities might be for men's legitimate sexual interests. 

Now even if we could see them are these unproblematic?  Well no exactly; we've got a bit of an idea that sexuality is one of the arenas in which a lot of these tensions about masculinity act themselves out.  Men's sense of sexual inadequacy compared with hegemonic masculinity.  Brad Pitt's up there as the guy that's sexy; the rest of us, yeah we've got no chance of doing anything in this particular game.  So this is an area in which men's sense of inadequacies and being second-rate or worse, may drive the agenda even further than we often think and may be behind some of the things that we find as problematic in men's sexual behaviour.

Another major dynamic, apart from sexuality, is the sexual division of labour.  This is a classical sociological term; it has many different meanings but we still do have a highly gendered division of all sorts of labour in our culture in some ways.  Workforce participation rates are quite different and understanding that fact about Australia and then looking at its links to OH&S issues is quite an important thing.  Men still do the hardest and the dirtiest jobs, there's no shadow of a doubt about that.  It's the men who are underground, it's the men mainly who are on the ships, it's the men that are on the offshore gas oilrigs most of the time and that has implications in that gender division of labour for men's health.

Work related stress, we all know what that is, but there are more men in the workforce and more men in stress related jobs than in women and so that gender division of labour produces in men health consequences and related to the workforce.  So OH&S issues for men are structurally driven by the nature of men's participation in the workforce.  It's not just about individual risk-taking which is how the literature often sets this up; oh he's a dum-dum in the workplace, he doesn't know what to do. 

These are in fact issues about where men are placed in the organisation of the workforce in this country and why they're in certain jobs and not others and how we regard that when we think about gender and workplace issues.  This is not just about the men at the bottom of the heap either.  There's that great saying in Australia, money doesn't make you happy and we all know that's true at one level.  A lot of money might make you quite happy some of the time I'm sure, but we do know - I mean I don't want to be Clive Palmer, just look at his girth for starters.  This is not a well man in any circumstances. 

So there's something also to be said about the way in which workplace participation at the top end of the hierarchy may actually be bad for your health.  It's not just something that's about working down the mine and one might ask about the highly competitive high-achieving end of masculinity in the workplace and the dangers that it produces for men and therefore the people around them at the same time. 

The issue of alcohol and drug use is a common one for men as well.  What we don't often know about is the links between workplace participation jobs and alcohol and other drug use and what the connections might be.   But if you think about fly-in fly-out and what's going on in Western Australia, South Australia and Queensland at the moment for younger men who are going off on to these oilrigs for 6 weeks and then they get 6 weeks in Bali paid for by the company, you start to ask some questions about their sexual lives and their alcohol and drug use in relation to that kind of organisation of the workplace.  Again a structural issue, not just an individual proclivity to sex and drugs and rock'n'roll. 

So thinking about these drivers underneath is quite important and if you can look at the consequence of this in some ways I'd point to Men's Sheds which we put up on the pinnacle as being a terrific achievement in this country and a real innovation and indeed it is, but where is the need for these sheds come from?  They originally came out of isolated men in mining towns in Victoria who'd spent their whole lives with men down underground and they'd come out at 65 and they have no friendships in their social life.  The only person who really sees what's going on for them is their wife if they have one and these men were literally suffering isolation, depression and alcohol and drug use because their whole life had been spent outside building the skills and relationships to support their retirement. 

And that's where the Men's Shed movement started because we knew these men lacked the sociality in their lives to live a life outside under the mines and that's where that idea grew from.  So we have to ask some really serious questions here about older men's' health and workforce participation and the gender division of labour in the workforce to look at some of those situations.  So when we come to cardiovascular degrees of older men, let's peel the onion back not just to their eating habits but look where this might relate all the way through to their getting in to the workforce and where and why they got there and how it went through as a lifestyle after there was a life lived after that.

The next one is the expectations of the body at work particularly men doing physical labour and there's less of that going on in our culture nowadays, but men doing physical labour.  The body is the only resource that they have and as the body ages and breaks down or is subjected to stress itself, men's sense of self which comes from a capacity for the body to do what you want it to do.  Remember the First XI again?  We all want to be in there, we all want our bodies to be that good and if they're not that good and then they start breaking down anyway there's a real level of stress and health-related diseases to a man pushing his body in certain kinds of ways. 

And we see some of the versions of this in sport and in extreme sports with men in particular taking much higher levels of risk than women in those areas.  But we also see it among young men at the moment, this emphasis on the body and making the body function the way it needs to function in increasing levels of anorexia and bulimia in teenage boys.  We have to ask what that's about in terms of masculinity and pressures to be a certain kind of boy, but also increases in gym use, stress fractures and the use of supplements and/or drugs in body building for teenage boys as well. 

So we've got a very powerful dynamic going on here in terms of the masculinisation of boys and the role of hegemonic masculinity is the goal we still ask them to achieve and fail at and what's happening among our young men at the moment, not just at the individual level.  We are looking at a whole age and generation of young men with eating disorders of both kinds and gym related behaviours and sporting related behaviours that are dangerous and we have to ask some underpinning questions here, not questions about the individual boy's psychological makeup. 

And undoubtedly we get a whole lot of sexual anxiety - back to this one again - for young men in particular and older men.  I happened to get today just as I was arriving; my best read every month is Men's Health magazine because this is the one that I think epitomises what we positioned for young men so I went through it and had a look.  So we've got here, How to Improve Your Online Love Life.  Now what does that tell us about what's going on for men at the moment?  Get Biceps like Vin Diesel - you all know who Vin Diesel is?   You know he talks about his guns; these biceps are called guns in his case, but I went through and had a quick look at some of the things that are in here. 

So what do we get?  Of course there's the classical sex page of this magazine.  Now this is one of the biggest read magazines in this country.  We look at this; so health is now about these kinds of things and of course what do these kinds of things really tell you?  You're not up to the mark because if you need all of these hints you're not in the First XI of love-makers like Brad Pitt.  Brad Pitt knows what to do already.  It's the rest of our sexual classes that don't.  So this is what we're being told here and if we're not just being told it about sex then we're also being told about how to be a man generally.  So what is wrong with your masculinity and how to make it work properly. 

And then you get as well once you get it right of course you've got to look like this and spend a whole lot of money dressing down as this particular fashion outfit is about dressing down to look like - and of course if you're over the age of 35 and you don't look anything like this then you're never going to so you've failed already.  And that's the main age for this magazine's readership, it's 35.  And then of course even no matter how far you go to the gym you're going to lose anyway because there's always someone who's going to kick your arse.  The bloke that can stand on your face in the First XI is always there and he's just waiting for you to try. 

Now this comes out once a month and I've been watching this magazine for 10 years now and what I would argue is what this stuff does is mainly produce anxiety in order to get you to consume.  You smell bad on page 36, the fix is on page 37 and it's a new perfume from Calvin Klein.  If you've got a flabby tummy on 38, on 39 there's an abs thing and a supplement that you can eat that will burn the fact off your gut quicker than you can say - I don't know, somebody [laughing]. 

So that's the kind of stuff which is going on here.   I think at a cultural level we ought to be watching at the moment, not just for the kind of stuff we understand about hegemonic masculinity and the drive to achieve something that is unachievable, but the way in which this is now commodified in contemporary capitalism to make sure that men maintain a permanent level of inadequacy that can now be solved through the gym which costs money, through the supplements that cost money, through the fashion that costs money, the perfumes that cost money.  All of those kinds of things that - this is very clever stuff because no one really knows that most men are walking round with a permanent level of anxious failure inside them in which they are looking constantly for a solution in some kind of way. 

So this all comes to rest in health and in other places in various kinds of ways.  But the notion that somehow that men must compete to get in to the First XI and to stay there, that level of competition in which most of us fail creates I think a very important dynamic in Australian masculinity.  There are countervailing dynamics, mateship, looking after your mate is another kind of countervailing dynamic.  It's not all a one-way street, it's very complex, but I think we do need to understand that.

The second thing is that this production of this kind of masculinity undoubtedly rests on institutional forms of sexism and misogyny and it's not that I'm voting for the Prime Minister this year when I raised that question.  Sexism and misogyny are still prevalent in this country, there's no shadow of a doubt about that and I'm sure that every woman in this room and a number of the men would agree with that without any shadow of a doubt.  The issue we often forget about is what's men's investment in this in relation to masculinity?  Why in fact do we construct masculinity as being unwomanly as a way in which you try and judge yourself because that's really part of the dynamic of the relation between the genders which produces masculinity dynamics. 

But also heterosexism and homophobia are involved in here because to be a real man you can't be a woman and you can't be a pufta.  They're the two messages that everybody gets really strong.  And so any man that's experienced any sexual ambivalence in his whole life, a small erection in the showers when you're 15 which is the most erratic time for erections in any boy's life - you can get an erection smelling an onion when you're 15 you know.  But it might happen that you're in the showers at the gym and that [clicks fingers] moment of uncertainty happens.  The 20 per cent of all Australian men that might have had one homosexual experience in their whole life carry around the fear that they might be gay permanently just because of one accidental experience.


So homophobia and heterosexism sits in underneath alongside misogyny and sexism as two things not to be if you're going to ever get anywhere close to being a hegemonic male.  Now remember hegemony here is an idea, the majority of men are not like that.

In terms of dealing with the health system we know what the figures are about men's lack of coming forward to the health system.  We know there are specific kinds of conditions and diseases, but what we don't often think about is depression and anxiety for men and how it operates.  We're slowly getting that on the agenda in this country thanks to Beyond Blue and a number of other agencies.  I'm working in prostate cancer and I'm working on a project on prostate cancer and gay men where two potential sources of depression, one about sexuality in a straight world and the other about cancer coincide. You won't find an article in the academic literature on that issue anywhere in the world.  It's one of the reasons I'm doing the work. 

Issues to do with social isolation in single men.  Increasingly men are living on their own; marriages are failing, they're not repartnering, a larger proportion of Australian men are living on their own and we have to ask that's not just about individual personalities and proclivities and marriage failures.  There's something going on in Australian cultural life that is producing increasing numbers of people living alone and particularly for men the outcomes are worse.  Why is that?  What's the structural underpinnings of that rather than the individual problems that may move along? 

And lastly I'd want to put the reproductive cancers on the list which often get lost.  There's 20,000 men diagnosed with prostate cancer over that each year which is larger than the diagnoses for breast cancer yet we can't seem to get the traction on that area that we need to do.  It's taken a long time to get traction on HPV and vaccination for young men in this society; it's taken years to get the government to agree to that, yet we've known the science for a long time.  Why is it that the boys don't seem to count?

So take home message.  Boys, boys, boys, boys; how do we raise them, how do we deal with issues that we are seeing in young men in football in terms of sex and drugs and behaviour?  How do we help parents raise boys because that I think is the key it seems to me that is helping parents raise boys.  Thinking about men's health not as just as individual men with conditions which is where we tend to focus, how to get a man with heart disease to a therapist, to a clinic, how to get him to change his diet.  Thinking about less on individual men's character flaws and thinking about their structural issues. 

These underpinning issues of social and economic and cultural drivers of how men live their lives and workplaces because good policy needs to address structural issues otherwise it will only ever work on the surface.  So I'm really, really wanting to stress that we need to do that.  The second our institutions, it's a level down from the structural issues, schools, religion, the military, prisons, workplaces; how do we work with institutions and their gender regimes as Connell calls it so that they become places in which masculinity is not just used as a weapon or a tool but can become one of the sites of reconfiguring masculinity so that we can start thinking about men.  Schools are easy because we know about sex roles, but try and think about rethinking gender in the Australian Defence Force and what we rely on to produce soldiers and you might come to see what some of the problems might be and try and deal with underpinning issues.

And finally communities and families and the interpersonal levels.  This is where we see the consequences.  We see it in domestic violence; we see it in individual health.  Yes we need to work there and the Victorian strategy really focuses cleverly on communities and families and these resources, but I'm arguing that we must also remember the institution and the structural level if we're going to actually shift the building blocks that then take root and are exemplified and acted out at family and community level. 

Thank you.

Reviewed 09 September 2021